The Alaska State Medical Association was not one of them. But that was because of logistical—not philosophical or political—reasons.

"We would have signed it," said Jim Jordan, executive director of the ASMA, but he was in Bern, Switzerland the day the letter was released. "Why wouldn't we support getting this fixed?"

He noted that in the city of Anchorage, where half his state's population resides, 40% of eligible physicians have opted out of Medicare.

"In good measure, it's due to the uncertainty in the Medicare program," Jordan explained, adding that the numerous short-term fixes to the SGR have not helped.

The annual report on doctor discipline compiled by the Federation of State Medical Boards will be out in a few weeks and, a few days after that, the Public Citizen consumer advocacy group will release its ranking, based on FSMB data, of how well different states are doing on policing physician misbehavior.

While I had him on the telephone, I had to ask Jordan about it because, after Alaska's four-year run at the top of the list, Louisiana's board knocked Alaska down to second place last year.

"We have a very good relationship with the medical board," Jordan said. "The medical board is expected to do what its statutory responsibilities are and that is to determine the appropriate licensure actions."

Naturally, Minnesota officials don't like the comparison. "I always ask people where they would rather go for healthcare: Alaska or Minnesota?" Robert Leach, executive director of the Minnesota Board of Medical Practice, told Modern Healthcare two years ago.

I asked Jordan to respond. He declined, explaining that he wasn't totally clear on the criteria Public Citizen uses. Even though he was claiming severe jet lag after a 30-hour trip, he was clear enough to give the diplomatic answer.